APPLICATION FORMAT

Candidate
should paste
recent Passport
size photograph
duly attested by
Gazetted Officer

Application for Engagement of Act Apprentices under Apprentices Act1961

for the year 2014-2015 at CLW/Chittaranjan
Notification No. TS/157/AITT (Part)/2015 dated: 24.7.2015.

1.

Trade applied for ( Item-1(A) or 1(B) of Notice)

2.

Trade of ITI certificate with year of passing

3.

Full Name (In Capital letter)

4.

Fathers Name

5.

Occupation Details of Father/Mother

(applicable to Railway Servant only)

6.

Educational Qualification details (Item - 6)

7.

Ex-Serviceman details (Item - 4)

8.

Physically Handicapped details (Item -3)

8.
DD
10.
UR

Desig./T/No.

Date of Birth
MM
YYYY
Community (Tick)
OBC
SC

9.
Year
11.

17. Visible marks of identification

(Moles/Cut Marks etc. on your body)
Year of
passing

Rlys.

Age as on 01.07.2015
Month
Days

13. Nationality
14. Religion
15. Sex (M/F)
16. Marital Status

Pin Code-

Matriculation/10th
Class (10+2)

Division

Category (Tick)
Ex-Serviceman
PWD

ST

12. Address for communication

18.

Cont. No./
P.F. No.

(i)
(ii)
Board/Educational
Institution

Total
Marks
obtained

Full marks Percentage

of exam

(Attested copies should be attached by the candidate)

19.

ITI from
NCVT

Year of
passing

Board/Technical Institute

Trade

Percentage

(Attested copies should be attached by the candidate)

20. Details of Bank Draft/IPO with date ________________________________________________

21. Number of enclosures ___________________________________________________________
22. Declaration by the candidate & father/mother:
A) We do hereby declare that all the statements as mentioned in the above application are true, complete and correct to
the best of our knowledge and belief. We understand that in the event of any particular information given above is
found false or incorrect, the applicant herein may be dismissed from Apprenticeship at any stage without notice.
B) We also understand fully that the obligation under Apprentice Act1961 on the part of the Railways is to provide only
training in the allotted trade and not to give employment in the Railways on completion of the training and thus we have
no right to claim for employment at CLW/Chittaranjan for the same.

Place:
Date:

Phone Number
Signature of father/Mother

Signature of the candidate

ANNEXURE-I

FORMAT OF INCOME CERIFICATE FOR WAIVER OF EXAMINATION FEES FOR

ECONOMICALLY BACKWARD CLASSES/SECTIONS
(To be issued on the letter Head of the Issuing Authority mentioned below)

1.

Name of Candidate

2.

Fathers /Husbands Name

3.

Age

4.

Residential Address

5.
6.

Annual Family Income

(in words & figure)
Date of Issue

7.

Signature of Issuing Authority

8.

Stamp of Issuing Authority

(Name of the Issuing Authority)

Note: Economically Backward classes will mean the candidates whose family income is
less than Rs.50000/- per annum.
The following authorities are authorized to issue income certificate to be issued on the letter
head of the issuing authority for the purpose of identifying economically backward
classes/sections:
1. District Magistrate or any other Revenue Officer up to the level of Tehsildar.
2. Sitting Member of Parliament of Lok Sabha for persons of their own Constituency.
3. BPL card or any other certificates issued by Central Govt. under a recognized poverty
alleviation programme or Izzat MST issued by Railways.
4. Union Minister may also recommend for any persons from anywhere in the country.
5. Sitting Member of Parliament of Rajya Sabha for persons of the District in which these MPs
normally reside.

ANNEXURE-II

SELF DECLARATION OF MINORITY CANDIDATES FOR WAIVER OF EXAMINATION FEES

Pro-forma for declaration to be submitted by minority candidates along with application for
engagement of Act Apprentices against Notice No. TS/157/AITT(Part)/2015 dated: 24.7.2015.

DECLARATION
I son/daughter/wife of
Sri/Smt.... Resident of
Village/Town/CityDistrict
State hereby declare that I belong to the ...
(indicate minority community notified by Central Govt. i.e. Muslims/Sikhs/Christians
/Buddhists/Parsis).

Date.

Signature of the candidate.

Place.

Name of the candidate.

NOTE: At the time of interview, such candidates claiming waiver of Examination Fees will be
required to furnish Minority Community Declaration affidavit on Non-Judicial stamp
paper of Rs.10/- that he/she belongs to any of the Minority community notified by the
Central Government.

CALL LETTER
Engagement of Act Apprentices under Apprentice Act1961 at CLW for the year 2014-2015
(To be filled by the Applicant in his own hand writing)

Notification No. TS/157/AITT(Part)/2015 dated: 24.7.2015.

Candidate
should paste
recent Passport
size photograph
duly attested by
a Gazetted
Officer

1. Name of the candidate:

(In Capital Letter)

___________________________________________

2. Fathers name:

___________________________________________

3. Correspondence address: ___________________________________________

(with Police Station)
___________________________________________
___________________________________________
4. Nearest Railway Station:

___________________________________________

FOR OFFICIAL USE (To be filled by the office)

You are directed to appear for verification with your original testimonials and Physical
fitness in ___________________________, CLW/Chittaranjan. If the candidate fails to
attend the same as on date _______________, he will not be given other chance. No
TA/DA will be given.
Seal & signature of the Authority